Obstructive Sleep Apnea

Obstructive Sleep Apnea

Obstructive sleep apnea occurs when a child stops breathing during periods of sleep. This stoppage of breathing usually happens because of a blockage (obstruction) in the airway. Tonsils and adenoids (lymph tissue located in the back and to the sides of the throat) may grow to be large relative to the size of a child’s airway (passages through the nose and mouth to the windpipe and lungs), and they may block the airway during sleep.

What happens when the airway gets blocked (obstructed)?

During episodes of blockage, the child may look as if he/she is trying to breathe (the chest is moving up and down), but no air is being exchanged within the lungs. Often these episodes conclude with a gasp and a period of awakening. Periods of blockage occur regularly throughout the night and result in a poor, interrupted sleep pattern.

Sometimes, the inability to circulate air and oxygen in and out of the lungs results in lowered blood oxygen levels. If this pattern continues, the lungs and heart may suffer permanent damage. Obstructive sleep apnea is most commonly found in children between three to six years of age. It occurs more commonly in children with Down Syndrome.

What causes obstructive sleep apnea?

In children, the most common cause of obstructive sleep apnea is enlarged tonsils and adenoids in the upper airway. Infections may cause these glands to enlarge. Large adenoids may completely block the nasal passages and make breathing through the nose difficult or impossible.

There are many muscles in the head and neck that help to keep the airway open. When a person (child or adult) falls asleep, muscle tone tends to decrease, thus, allowing tissues to fold closer together. If the airway is partially closed (by enlarged tonsils and/or adenoids) while awake, falling asleep may result in a completely closed passage.

Obesity may cause obstructive sleep apnea. While a common cause in adults, obesity is a far less common reason for obstructive sleep apnea in children.

A rare cause of obstructive sleep apnea in children is a tumor or growth in the airway.

What are the symptoms of obstructive sleep apnea?

Each child may experience symptoms differently, however, these are the most common ones:

  • Loud snoring or noisy breathing during sleep.
  • Periods of not breathing.
    Even though the chest wall is moving, no air or oxygen is moving through the nose and mouth into the lungs. The duration of these periods is variable and measured in seconds.
  • Mouth breathing:
    the passage to the nose may be completely blocked by enlarged tonsils and adenoids
  • Restlessness during sleep (with or without periods of being awake)
  • Excessive daytime sleepiness or irritability (because the quality of sleep is poor)
  • Hyperactivity during the day

Always consult your child’s physician for a diagnosis because the symptoms of obstructive sleep apnea may resemble other conditions or medical problems.

How is obstructive sleep apnea diagnosed?

Call your child’s physician if he/she experiences noisy breathing during sleep or if snoring becomes noticeable. Your child may be referred to an otolaryngologist (physician who specializes in disorders of the ear, nose, and throat) for further examination.

The physician will start with a complete medical history and physical examination of your child. These diagnostic procedures may be added

  • Sleep history, a detailed report from parents or caretaker
  • Evaluation of the upper airway
  • Sleep study (also called polysomnography), the best test available for diagnosing obstructive sleep apnea

What happens during a sleep study?

A sleep study requires a high level of cooperation from the child and may not be possible in younger and/or uncooperative children. Two types of sleep studies are available. For the first type, the child will sleep in a specialized sleep laboratory while being monitored carefully throughout the night. With the second type, the child wears similar monitors but sleeps in his/her own bed.

During a sleep study a variety of testing occurs to evaluate the following:

  • Brain activity
  • Electrical activity of the heart
  • Oxygen content in the blood
  • Chest and abdominal wall movement
  • Muscle activity
  • Amount of air flowing through the nose and mouth

During the sleep study, episodes of apnea and hypopnea will be recorded. Apnea is a complete airway obstruction lasting at least five to 10 seconds. Hypopnea is a partial airway obstruction that is combined with a significant decrease in the oxygen content of the blood.

Based on the sleep study, sleep apnea is generally considered significant in children if more than 10 apnea episodes occur per night, or one or more occur per hour. Some experts define the problem as significant if a combination of one or more episodes of apnea and/or hypopnea occur per hour of sleep.
How is obstructive sleep apnea treated?

Your child’s physician will develop a specific treatment plan for your child based on:

  • Your child’s age, overall health, and medical history cause of the condition
  • Your child’s tolerance for specific medications, procedures, or therapies expectations for the course of the condition
  • Your opinion or preference

The treatment for obstructive sleep apnea is based on the cause. Your child’s otolaryngologist will discuss the treatment options, risks, and benefits with you. Enlarged tonsils and adenoids are the most common cause of airway blockage in children, and if this is the case for your child, surgical removal of the tonsils (tonsillectomy) and/or adenoids (adenoidectomy) may be recommended.

If obesity is the cause, less invasive treatments may be possible, including weight loss and wearing a special mask while sleeping to keep the airway open. This mask delivers continuous positive airway pressure (CPAP). Because the device itself is often clumsy, it may be difficult to convince a child to wear such a mask. In those cases, surgery may be necessary.